Help patients beat the “holiday blues”

The holiday season is classically known as a happy time of year, but this is not always the case for some patients. 

During these months, the holiday season can trigger stress related to increased expectations, finances, and family interaction, but it typically resolves once the holidays are over. However, there are other conditions that can persist past the holiday season and may require more intervention to resolve.

Moreover, patients living in cold weather climates often face symptoms consistent with Seasonal Affective Disorder (SAD). Reduced sunlight from lake-effect and daylight-savings strategies can cause a drop in serotonin levels that may trigger depression. SAD, which is a characterized by a decline in mood and associated symptoms, typically occurs in the fall and winter months, when there is less sunlight, cold weather, less outdoor activities, noted reductions in social interaction, and increased isolation. 

Providers don’t have to practice in mental health to have an impact on patients with these concerns and disorders. We have the power to identify, treat, or refer patients to a higher level of care, and in some cases, save a life.  

Here are a few ways we can help patients who deal with stress and depression during the holidays and winter months:

• Encourage patients to avoid overindulging and to moderate intake of all food and alcohol to help regulate emotions during these stressful months. Urge patients that are prone to depression or the holiday blues to include more fresh foods, raw vegetables, and fruit in their diets-these foods are known to boost serotonin and dopamine in the brain, improving an individual’s mood.  

• Ask patients to continue with their regular medication routine. If they are on an antidepressant or mood stabilizer, encourage them to maintain compliance and keep up with refills to ensure they don’t run out of supply.

• Recommend that patients maintain or increase their physical activity. Increased activity releases endorphins (mood helpers) at greater levels. 

• Suggest patients talk about how they are feeling to friends, family, or trusted counsel. If their feelings are ever accompanied by suicidal thoughts with a plan, encourage them to call 911, immediately go to the emergency room, and/or contact National Suicide Prevention Lifeline at 1-800-273-TALK.

• Explain to patients the benefits of getting outside of themselves, in a healthy way, and practicing self-care whenever they can. That may be by volunteering for those less fortunate, practicing guided meditation and mindfulness (the Calm® app is great), immersing themselves in nature, and increasing sun exposure. Numerous studies show that spending time in nature improves concentration, decreases inflammatory markers, and improves energy.

• Develop a mental health toolkit for your practice with ‘ready to use’ resources for providers and patients, including mental health screening tools for different diagnoses. Connect with local National Alliance on Mental Health (NAMI) chapters or research local mental health affiliates to form a community calendar of holiday events that are open to the public, make a list of Alcohol and Narcotics Anonymous meetings in your area for those with addiction, and collect healthy, easy-to-make holiday recipes. NAMI and Mental Health America have good examples of patient handouts that can be accessed online and easily printed. Also, don't forget about the providers and office staff, because this season can be overwhelming for them too. Offer a workplace wellness activity like yoga or meditation to ease any provider burnout. 

• Assess all patients’ susceptibility to substance abuse, which can increase during the winter months. In particular, maintain an open dialog with teenagers in your practice as this population is more likely to resort to drugs and alcohol to cope with emotional distress.  

While the festive spirit of the holidays sweeps the country, it’s important that we remain cognizant of the “holiday blues” that can take hold of patients who may be particularly vulnerable to these messages. 

Working in mental health has taught me a lot about resilience, and I am grateful to play a part in patients regaining control of their lives. There isn’t a cure for a lot of the conditions I treat, but I am a firm believer in collaborative care and utilizing resources outside of your practice to help patients. Psychiatry is a team sport, and I have had the privilege of working with some of the brightest minds in the field.

Nelae Keene, PA-C, works at Orange County Psychiatry and Addiction Medicine in Costa Mesa, CA. Keene has had extensive training and experience treating adolescents and adults with substance abuse and complex psychiatric issues. She is able to perform initial and follow up psychiatric evaluations, provide a diagnosis, treat with medication, and refer for psychotherapy. Keene has interests in natural and alternative medicine and was a 2011 recipient of the Natural Medicine Comprehensive Database Recognition Award, an award that recognizes those with a dedication to evidence-based uses of natural medicine.

This blog was written in conjunction with the National Commission on Certification of Physician Assistants.